Diabetes and pregnancy

The information on this page is relevant to you if you were diagnosed with type 1 or type 2 diabetes before you got pregnant.

It does not cover gestational diabetes. Gestational diabetes is high blood glucose (sugar) that develops during pregnancy. It usually goes away after the baby is born.

If you have type 1 or type 2 diabetes, you will usually go on to have a healthy baby. But there are some possible complications you should be aware of.

Managing your diabetes well before and during your pregnancy will help to reduce these risks.

What it means for you

If you are pregnant and have type 1 or type 2 diabetes, you may be at higher risk of having:

• a large baby - which may increase the risk of a difficult birth or a caesarean section
• a smaller baby
• a miscarriage
• early delivery
• low blood glucose (hypos)
• high blood glucose levels
• blood pressure problems

Risk of complications from diabetes

You are also at risk of developing problems with your:

• eyes (diabetic retinopathy)
• kidneys (diabetic nephropathy)

You can also develop diabetic ketoacidosis. This is where harmful chemicals called ketones build up in the blood.

Anyone with diabetes is at risk of these complications. But pregnancy can increase the risk.

What it means for your baby

If you have type 1 or type 2 diabetes, your baby may be at higher risk of having:

• low blood glucose levels
• low calcium
• jaundice - yellowing of the skin and whites of the eyes. This is common
• health problems shortly after birth, such as heart and breathing problems, and needing hospital care
• obesity or diabetes later in life

It is rare, but there's also a slightly higher chance of your baby:

• being born with birth defects, particularly heart and nervous system abnormalities
• being stillborn
• dying soon after birth

Managing your diabetes well, before and during your pregnancy, will help to reduce these risks.

Reducing the risks

The best way to reduce any risks is to manage your diabetes well before you get pregnant.

Ideally, plan to get pregnant at a time when your diabetes and any medical complications you have are very stable.

You should:

• have a HbA1c of below 48mmol/mol before you become pregnant
• keep your HbA1c between 42 to 48mmol/mol when you are pregnant

High blood glucose levels in the first 8 weeks of pregnancy can increase the risk of miscarriage and birth defects in your baby.

Avoid smoking, alcohol and recreational drugs.

Check for diabetic ketoacidosis

If you have type 1 diabetes, you should check for diabetic ketoacidosis. You'll be given testing strips and a monitor to test your blood ketone levels.

Use these if:

• your blood glucose levels are high
• you are getting sick or have diarrhoea

Planning your pregnancy

Before you start trying for a baby, talk to your doctor or diabetes care team for advice. You should be referred to a diabetic pre-conception clinic for support.

Blood glucose

Make sure your blood glucose levels are well controlled before you become pregnant. Your diabetes team can help you with this.

You should be offered a blood test (called an HbA1c test). This shows your average blood glucose over the previous 2 to 3 months.

It's recommended your HbA1c level is less than 48mmol/mol before you get pregnant. If you cannot get your level below this, then try to get it as close as possible. Every improvement reduces the risk of complications for you and your baby.

If your HbA1c is above 86mmol/mol, it is advised not to try for a baby. Your care team will help you to reduce it.

You should continue using contraception until your blood glucose is controlled. Your GP or diabetes specialist can tell you how best to do this.

How to check your blood glucose levels

Folic acid

You'll need to take a higher dose (5mg) of folic acid every day:

• for at least 12 weeks before you get pregnant
• until you're 16 weeks pregnant

This will reduce the risk of a neural tube defect (NTD) for your baby. Neural tube defects are birth defects of the brain, spine or spinal cord. Spina bifida is one type of neural tube defect.

There's a higher risk of your baby having an NTD if you have diabetes.

You can only get 5mg folic acid tablets on prescription. Your doctor or diabetes team can prescribe this for you.

When you become pregnant

Keeping your blood glucose levels stable can be harder in early pregnancy as your hormones change, especially if you have morning sickness.

Blood glucose changes can happen more easily. Check your glucose levels often. Carry hypo treatment with you in case your blood glucose goes low. Follow the safety advice your team gives you.

You'll usually have regular check-up appointments with your maternity and diabetes teams. You'll also have extra tests and scans.

Diabetes treatment during pregnancy

Ask your diabetes team for a review of your condition and the medicines you are taking. This to check that they are safe in pregnancy.

Your diabetes team may recommend changing your treatment during pregnancy.

Check your medicines

If you take tablets to manage your diabetes, you'll normally be advised to:

• stop taking these medicines (except metformin)
• switch to insulin

If you already use insulin to control your diabetes, you may need to switch to a different type of insulin.

If you use an insulin pump, you can continue to do so during pregnancy.

If you take medicines for high blood pressure or high cholesterol, these may also need to be changed.

Attend all appointments

It's important that you attend all your appointments.

This is so that your diabetes and obstetric teams can:

• monitor your condition
• react to any changes that could affect your or your baby's health

Nausea and vomiting in pregnancy may make your blood glucose levels more difficult to control. You will need to check your levels more often. Your diabetes and obstetric teams can advise you as to how best to manage this.

Diabetic eye screening in pregnancy

You will be offered regular diabetic eye screening during your pregnancy. This is to check for signs of diabetic eye disease (diabetic retinopathy).

The risk of diabetic retinopathy increases in pregnancy. But diabetic retinopathy can be treated, especially if it is caught early.

If you decide not to have the test, tell the doctor looking after your diabetes care.

Diabetic RetinaScreen in pregnancy

Labour and birth

You should give birth in a hospital with a maternity team led by an obstetrician.

You'll usually be advised to deliver your baby a week or two before your due date. This is to reduce the risk of complications of diabetes, particularly the risk of stillbirth.

Your obstetric team will help you decide the best timing and delivery approach for you and your baby.

Your blood glucose will be measured more often during labour and birth. You may be given a drip in your arm with insulin and glucose to keep your blood glucose at a normal level.

After the birth

Feed your baby as soon as possible after the birth, ideally within 30 minutes. This helps keep your baby's blood glucose at a safe level. Breastfeeding is usually the best option.

You may have saved colostrum that you can use to feed your baby while your milk supply is starting. This is often collected in late pregnancy. Your obstetric team will advise you on this.

Your baby will have their glucose monitored soon after they're born. This is to check if their blood glucose level is okay.

If your baby's blood glucose cannot be kept within a healthy range or they are having problems feeding, they may need extra care in the neonatal unit.

When you are leaving the hospital after the birth, your diabetes team will arrange your follow-up visit.

Your care after pregnancy

Talk to your healthcare team about the best contraceptive option for you before your discharge home.

In the days after your baby is born, you can usually go back on to the same diabetes medicines you were on before pregnancy. Talk to your diabetes team. They will help you decide what's right for you.

If you were on tablets before you became pregnant, your diabetes team will advise you about this.